Cholangiocarcinomas are rare malignancies arising from the epithelial cells of the intrahepatic and extrahepatic bile ducts. Surgical resection can be offered to patients in whom disease appears to be localized and potentially resectable, and is individualized according to the location of the tumor within the biliary tree: intrahepatic, perihilar, or distal. True resectability can often only be determined at the time of exploration.

A preoperative clinical staging system that accurately assesses resectability would be of value clinically. Such a classification, the Blumgart staging system, has been proposed that is based upon biliary tumor extent, the presence or absence of portal vein involvement, and the presence or absence of hepatic lobar hypertrophy [1,2]. In a series of 376 patients diagnosed with a perihilar cholangiocarcinoma whose disease could be adequately staged, this clinical T staging system accurately predicted resectability, metastatic disease, and the likelihood of a microscopically complete (R0) resection [3]. Independent confirmation of these results is needed.

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